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Payment gaps seen for child visits


Payments to physicians for child visits covered by private insurance were 70% higher in 2015 than for visits covered by Medicaid, according to the Agency for Healthcare Research and Quality.

Child visits covered by private insurance brought in a mean $214 for office-based physicians of all specialties in 2015, which was $88 more than the $126 they received for Medicaid-covered visits, the AHRQ said.

Mean total payments to office-based physicians per child visit

That gap has been consistent since 2010, even as payments rose from 2010 to 2013 and fell in 2014 and 2015. The payment gap was even larger in 2015 when looking at the most expensive 10% of child visits: $406 for those that were privately insured and $215 for those covered by Medicaid, the AHRQ reported in a recent Statistical Brief.

Variations in payments also were seen between geographic regions and among the different physician specialties. Mean payments to physicians in the Midwest were highest for both private insurance ($249) and Medicaid ($152), while the lowest payments – $192 from private insurance and $120 from Medicaid – went to physicians in the South. The South also had the smallest gap between private and Medicaid coverage at $72, and the West had the largest gap at an even $100, but none of the variation across regions was significant, the AHRQ said.
Mean total payments to physicians per child visit by region

There were statistically significant gaps between private and Medicaid payments by specialty, although only for visits to orthopedists ($423 private – $162 Medicaid = $261) and primary care physicians such as family physicians and internists ($174 private – $122 Medicaid = $52). Payments to pediatricians were $190 private/$115 Medicaid, and the psychiatrists’ $111 mean payment from Medicaid represented the lowest for any specialty, data from Medical Expenditure Panel Survey’s household component show.

Mean total payments to physicians per child visit by specialty
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